Comparison of nutritional status and growth curves of children and adolescents in the city of Goiânia, Goiás: cross-sectional study

ABSTRACT BACKGROUND: Nutritional status and growth curves can affect cognitive development, increase the risk of infection, and contribute to the development of chronic diseases. Its etiology is related to food, socioeconomic, and maternal conditions. However, to date, no data on these parameters exist in the state of Goiás, Brazil. OBJECTIVE: To compare the nutritional status and growth curves of children and adolescents in the city of Goiânia, Goiás, Brazil. DESIGN AND SETTING: This was a cross-sectional study. A total of 529 individuals were recruited from a primary health center in the municipality. METHODS: To assess nutritional status, the sample was divided into three categories: 3–4, 5–10, and 11–19 years, with z-score classification considering body mass index for age. The classification of growth curves was performed considering the median height values for age, assuming two references: (a) young Brazilian population and (b) one recommended for international use. The independent sample T-test was used to compare anthropometric variables. RESULTS: The results showed that the classification of eutrophics represents a predominant percentage between both sexes (men: 03–04 = 55.4%; 05–10 = 57.6%; 11–19 = 53.5 % and women: 03–04 = 53.5%; 05–10 = 63.9%; 11–19 = 56.9%), and growth curves showed differences in specific periods in both sexes. CONCLUSIONS: It can be concluded that children and adolescents from the city of Goiânia present as predominance the eutrophic nutritional status, followed by the risk of overweight, underweight, obesity, and malnutrition of both sexes.

Growth curves enable the observation of the growth patterns of healthy individuals under environmental and social conditions favorable to their development. Thus, this instrument makes it possible to analyze and compare growth parameters in different regions of Brazil and other countries, observing the health condition of children and adolescents, 12 not only the risks of malnutrition but also the prevalence of overweight and obesity in this population. 7 These nutritional states may contribute to the early development of chronic diseases, such as cardiovascular and metabolic, 9 and may reduce the life expectancy of this population. 10 Growth curves are internationally accepted standards for observing differences between populations or subgroups in a given region with regard to the health condition of children and adolescents. 12 Therefore, the control of nutritional status and physical growth can contribute to the prevention of diseases and the creation of government actions to improve the quality of life of the general population.

OBJECTIVE
This study aimed to compare the nutritional statuses and growth curves of children and adolescents in the cities of Goiania and Goiás, Brazil.

METHOD
To compare the nutritional status and growth curves, data were A priori sample analysis revealed that to achieve a 0.5 effect size (ES) with a power of 0.95, a total of 210 participants would be necessary. Therefore, 529 participants were recruited to account for eventual attrition, which was approved by the Ethics Committee in Human Research, Universidade Federal de Goiás (CEP/ CAAE:64091717.0.0000.5083), on March 9, 2017. All procedures were performed in accordance with the Declaration of Helsinki.
The classification of physical growth curves (Figures 1 and 2 14 and (b) recommended for international use by the World Health organization. 13 The normality of age, body mass, height, and body mass index data was analyzed using the Kolmogorov-Smirnov test. For comparison between variables, the t-test was used for independent samples for parametric data and the Mann-Whitney test for non-parametric data. Statistical significance was set at P < 0.05.
The growth curves between men and women (Figures 1 and   2) demonstrated differences between the sexes at 7 and 9 years, as well as between 15 and 17 years, with higher values for men.
However, a decline in the curve for men aged 13 and 15 years was demonstrated when compared with the IBGE and WHO data.

DISCUSSION
This study aimed to verify the nutritional status and growth curve of children and adolescents in the city of Goiânia, Goiás. The results showed that male adolescents aged 16-19 years had greater heights and body masses than female adolescents. Regarding nutritional status, male and female children and adolescents had a higher prevalence of eutrophy; however, overweight and obesity were observed in all age groups. In addition, we found a significant difference between sexes in height and body mass in the age group of 16-19 years (P = 0.00 and P = 0.00, respectively).
Additionally, body mass, height, and nutritional status are related. In a systematic review by Junior et al. 15  Regarding the growth curve, at the age of 19 years, a similar curve was verified among men in our study with IBGE data from     criteria. This demonstrates that Goiânia adolescents present a shorter stature compared with the two references adopted. This is justified by the average height of the population of Goiania, which is 1.75 cm for men and 1.78 cm for women, below those of the IBGE and WHO. 13,14 Regarding the findings on the classification of nutritional status, the results showed low percentages of obese adolescents with overweight in men (3.8% and 7.7%) as well as in women Additionally, the adolescent men in our study had a lower percentage of obesity (3.8%) compared with those in Chile (16.6%), which may be associated with the eating factors of the country; in addition, this divergence may have been influenced by the economic level and social differences, in which the higher the socioeconomic level and the lower the inequality, the higher the obesity, 13  However, HDI also appears to reflect the growth curve, and the study of Gomez-Campos et al. 22  This shows that the socioeconomic conditions in Brazil are better than those in some African and Asian countries.
In this sense, we find differences in the growth curve of our study compared with those of other countries in Europe. Riedlová et al. 23 analyzed 960 male children born in the Czech Republic aged 12 years. The mean height was 1.81 cm, which is higher than our findings (1.40 cm), as well as that of the WHO (1.79 cm). This difference may be related to the best living and feeding conditions of European children compared with those of Brazilian children. 21 In addition, genetic influences may also influence this variable. 24 Cultural aspects can also influence the growth curve as shown in a study conducted by Bahchachi et al. 25  Therefore, the differences in nutritional status and growth curve are directly related to the culture of countries, socioeconomic conditions, and public policies that each region implement within its own state. 28 Particularly at the end of adolescence and early adulthood, a relationship exists between the response to adverse events and weight changes. 29 One manner to improve the growth curve related to body mass may be the practice of physical exercise. Adolescents who practice physical exercise have adequate control of body weight; however, inadequate lifestyles can impair this development. 30 Our research has a significant sample and is an original study. Not research has yet evaluated the growth curve of children and adolescents in both sexes in the city of Goiânia. As a limitation, we did not assess the socioeconomic levels and levels of physical activity. These results can contribute to the creation of public policies in the city of Goiânia and the region, which aim to reduce the risk of overweight and obesity, in addition to improving aspects related to growth curves and consequently economic, social and cultural development, through the investment of public policies in the sectors inherent to these aspects.

CONCLUSION
Children and adolescents in the city of Goiânia present a predominantly eutrophic nutritional status, followed by the risk of overweight, underweight, obesity, and malnutrition in both sexes. A trend of increasing BMI over time exists. Additionally, the growth curve was lower than those of the WHO and IBGE levels. Despite the optimistic results regarding the percentage of eutrophication, the risk of being overweight is high among men and women, which corroborates with some epidemiological studies that demonstrated a prevalence relationship of overweight in developed regions when compared with less developed regions, demonstrating that improving access to information inherent to body mass control and general health is required. Additionally, further studies should be conducted in other regions of the state and country to verify the aspects inherent to the development of the population, which directly reflects national development.